One in Six Elite Track and Field Athletes Have Had Suicidal Thoughts

By Lisa Rapaport

March 30, 2020

(Reuters Health) - In a cross-sectional survey, many elite track and field athletes reported having experienced suicidal thoughts, suggesting that suicide prevention may need to be incorporated into more athletic programs, according to a report in the British Journal of Sports Medicine.

Among the survey participants, who were all athletes selected for the Swedish Athletics team between 2011 and 2017, the lifetime prevalence of suicidal thoughts was 15.6%. That compares to a 13.9% lifetime prevalence seen in a 2014 study of U.S. Army servicemen, but is lower than the 32.7% lifetime prevalence among college athletes reported in a 2018 multi-country study, the study team notes.

Women were almost six times more likely to experience suicidal thoughts when they had a history of sexual abuse, while men were 51% more likely to have suicidal thoughts if they tended to use avoidance as a coping strategy.

"Suicide prevention strategies among female athletics athletes should include targeting sexual abuse victimization and strengthening the athletes' personal psychological resources, while among male athletes the corresponding interventions should comprise coping strategies and problem solving skills," said lead study author Dr. Toomas Timpka, director of the Athletics Research Centre at Linkoping University in Sweden.

"At the societal level, efforts should be made to detect sexual abuse early and sports federations should formulate action plans for suicide prevention," Dr. Timpka said by email. "In parallel, sports clinicians must increase their general attention on improving the mental health of athletes."

Of 402 athletes contacted, 192 (47.8%) participated in the cross-sectional web survey. Retired athletes made up 28% of the participants. Questions included lifetime suicidal ideation, suicidal events, abuse experiences, sociodemographics, sense of coherence and coping strategies, as well as injury history.

Twenty (10.4%) of the participating athletes reported having sustained sexual abuse (15.1% among women and 4.7% among men), the study team reports. Five athletes (2.6%) reported sexual abuse in the athletics setting. In addition, 10.9% of participants had suffered physical abuse at some point in their life (14.0% of men, 8.5% of women). All abuse episodes had occurred more than one year before the survey.

Overall, 11.6% of men and 5.7% of women in the study reported experiencing non-sports injuries. Among women, non-sports injury was associated with having been sexually abused (OR 8.61) and participating in endurance events (OR 7.37). For men, having immigrant parents was associated with non-sports injury (OR 5.67).

"In addition to being at risk of sexual (and physical) abuse, athletes competing at the highest level also have to manage multiple other pressures affecting their mental health and these pressures can be aggravated by injury or failure to meet performance goals," Dr. Timpka said. "This mental load can lead to suicide ideation (thinking about, considering or planning suicide) and even suicidal behavior."

Because the athletes in Sweden benefitted from nationally-funded healthcare and education, results from the study might not be generalizable to the international population of elite athletes, the study team notes.

Researchers also lacked data on some relevant determinants of suicidal ideation such as previous episodes of clinically treated psychiatric disorders and the athletes' ethnicity.

"I suspect that there are sports-specific influences, selection bias, cultural differences, and a number of other factors that could lend itself to a higher prevalence of suicidal thoughts," said Dr. Ashwin Rao, a researcher at the University of Washington and a specialist at the Sports Medicine Center at Husky Stadium in Seattle.

Still, the results underscore that coaches should pay attention to athletes' mental health, not just physical health, Dr. Rao, who wasn't involved in the study, said by email.